PCP Turnover Costs a Billion Dollars in Excess Cost
There is a lot of news coming out about workforce shortages and physician turnover.
The American Hospital Association is urging Congress to address workforce challenges facing healthcare facilities, calling the issue a national emergency.
In a letter submitted to the House Energy and Commerce Committee March 1, the group said the workforce challenges “are a national emergency that demand immediate attention from all levels of government and workable solutions.”
The letter discussed the toll the COVID-19 pandemic has taken on healthcare workers, workforce shortages and how hospitals and health systems are supporting their employees.
The press is also running with this story so I guess I will too. Doctors. are burning out and quitting or retiring. When they do leave there is upheaval in patient care. This leads to patients going to ER for stuff they wouldn’t have done before:
There are multiple plausible reasons for the increase in health care expenditures observed when patients lose their PCPs. Continuity between patients and PCPs is important for quality of care9,11,12 and patient satisfaction4,3 as well as for total costs of care.49 If care shifts to higher-cost venues, such as the emergency department rather than the ambulatory setting, costs rise. For example, given the greater trust8,50 between patients and their physicians in an ongoing relationship, a course of observation may be more acceptable in the context of an established relationship, whereas an accelerated application of imaging and consultations may occur in the evaluation of undifferentiated symptoms outside of the context of an ongoing relationship. Finally, to the extent that patients replace primary care with non–primary care, they may receive more low-value care.51
So what does all this mean? Well, we need to work on issues that are making PCPs quit. Is it working? No. I just wrote my most recent book The Hospital Guide to Physician Retention: Why Creating a Physician-Friendly Environment Is Critical For Your Organization’s Success exactly for this reason. Making doctors do yoga retreats or taking resiliency classes will not fix the problem. In fact, my book won’t totally fix the problem. Without lessening the bureaucratic drag that drives physicians crazy then burnout won’t go away. But hospitals can do other things to help and since most PCPs are employed by hospitals then it behooves them to create a working environment that leads to superior loyalty and retention. Either they CREATE a great Physician Retention Program or they will lose doctors to the hospital down the street who has.
A million dollars to replace a physician?
That’s nothing.
Fire an administrator and save the hospital a million dollars a year in salary alone.
In fact, with all the debate over illegal immigration, I often wonder why we don’t get our hospital administrators from some Escuela de Negocios in Mexico City.
Surely a Mexican Escuela de Negocios could produce people willing to screw doctors and nurses for ten cents on the dollar to an American MBA.
Even better, find a Mexical administrator willing to treat physicians and nurses fairly.
You know, a job no American Administrator is willing to do.
The Pareto principle applies. 90%of the work and positive outcomes are done by 10 to 20% of the people.The
other 80% are just along for the ride.Happens in ALL organizations. Medicine is a business model.At the doctors independent practice, the Group practice or Hospital based group…All subject to whim,emotion ,perceived slights, someones more extensive knowledge on a subject or prior experience.. Arbitrary, capricious all dressed up in various HR metrics, surveys… Courage is hard, standing alone is hard,especially when you are right. You do it because it is the right thing to do.. There is Always a Cost.
PS: At the constitutional level where we work, 90 percent of any decision is emotional. The rational part of us supplies the reasons for supporting our predilections. Justice William O. Douglas
If honest jurists find that 90% of their decisions are emotional, in spite of a studied and trained predilection for dispassionate logic, what chance is there at a medical care institution that employment decisions will be made according to some rational basis? They are usually whimsical prejudices cloaked in bogus statistics. That is why power structures are inevitably clubby, and fairness can never penetrate them, no matter what pronouncements and rules are made against discrimination. You are only as good as the club feels that you are; and the club can include people outside your chain of command, even political underlings. Your boss is whomever has an opinion about you that influences your career or standing. Even if it’s the chainsmoking crone at the desk who’s chummy with the HR director’s sister. You are no more than what someone feels like you are. The Book of Press-Gainey
I curse Jack Welch of GE.
Of course, “rank and yank” is much more fun when applied to the slaves on the assembly line; not so fun when actual administrators get fired. So if the big cheese is doing it to the middle-management, it works even better when applied to the point-of-care help.
I. Cook up a rating system that is little more than random chance. You can’t do much better than that for healthcare – you would have to do actual case studies, which a) take a hell of a long time, and b) can’t be done by quality control grunts who check boxes. Rating performance is hard; rating tardiness isn’t.
II. Then jettison the bottom 25% of your hired staff, and replace them with “campesino physicians” (i.e. locum tenens contracts) and re-hire some fresh meat.
You will be left with an “upper crust,” or “slag” as termed in the metal refining industry – the useless crusty stuff that floats to the top. They can establish themselves as semi-permanent bumf-shufflers who can step on the fingers of anyone with ability, talent, skill, or other frightening elements.
The ones who are rated top-shelf 25% are inevitably slag. the bottom 25% are churned over annually. The middle 50% are insecure, faithful box-checkers, who occasionally get sucked down into the undertow of the bottom 25% and are turned over after a few years.
What this produces is unspeakable. Why it is standard operating practice is incomprehensible.